Understanding Addiction — For the People Who Love Someone Struggling

What if addiction isn’t a failure of willpower, but a failure of the brain systems that make willpower possible? In this episode Dr. Brenda Fann (who has been on the pod before) interviews me about addiction as we provide a clear, compassionate walk through what addiction really is, why it grips so hard, and how families can help without enabling. You’ll hear a physician’s lived experience of losing a spouse to alcohol use disorder, the science behind cravings and executive function, and the practical steps that move people from chaos toward stability.

We unpack the three C’s—cravings, compulsive use, and continued use despite harm—and translate them into everyday red flags partners and parents can actually spot. We explain how early exposure reshapes the adolescent brain, why withdrawal makes “just quit” dangerous advice, and what truly counts as a standard drink. From insomnia fueled drinking to masking trauma with stimulants, we explore how substances solve short‑term problems while creating long‑term damage—and how targeted treatment reverses that math.

Then we get tactical. Think of recovery as a three‑legged stool: medication to steady the biology, therapy to build skills and face trauma, and peer support to restore connection and motivation. For families, the parallel path matters: Al‑Anon or Nar‑Anon, counseling, and firm but fair boundaries. You’ll learn conversation starters that lower defenses (“Help me understand what you need from the alcohol”) and a simple rule for avoiding the “villain” role while still holding the line. We also break down the data on teens, vaping, and the myth that teaching kids to drink at home protects them—it doesn’t.

If you’re ready for a roadmap that blends medical insight with human kindness, this conversation delivers. Subscribe for more evidence‑based guidance, share this episode with someone who needs it, and leave a review so others can find real help faster.

To contact Dr. Grover: ammadeeasy@fastmail.com

Transcript

Welcome And Why This Conversation

SPEAKER_02 0:08

Hi, I'm Dr. Casey Grover. I spent years practicing emergency medicine before shifting my focus to addiction medicine. This podcast grew out of caring for patients, hearing their stories, and wanting to do better. Here we talk about recovery, medicine, and compassion. This is Addiction Medicine Made Easy. Today's episode is a bit different than what I usually do on this podcast. Now, if you remember back to the end of 2025, Dr. Fan joined us to share her story of what it was like living with a spouse with a terminal substance use disorder. Dr. Fan is a family physician, and she lost her husband to alcohol use disorder. We discussed how addiction is so hard on families. We discussed the stigma around addiction and how hard it can be to ask for help. So, Dr. Fan is writing a book and she is starting to work on helping other families who have a loved one with addiction. So for this episode, she actually put together a Facebook live session where she interviewed me as an expert in addiction to help people learn more about addiction, particularly those people who are living with a loved one with addiction or are close to someone with addiction. And of course, you know me, I am always looking for a good podcast episode. So I recorded it in addition to the Facebook live session to share with all of you as a podcast episode. We cover all sorts of topics about addiction in this episode with the goal of helping people who are close to someone with addiction understand what addiction is, how it affects the brain, and how to get them help. Here we go.

Dr. Grover’s Path Into Addiction Medicine

SPEAKER_00 2:02

There we go. Hello, everyone. This is Brenda. I'm here with Dr. Casey Grover, one of my colleagues. He's an addiction medicine specialist. And we're going to spend some time talking tonight about addiction. We're going to talk about the facts, we're going to debug some myths, and then we're going to talk through some practical insights. So I'm going to introduce myself first, what I'm doing and why, and then I'm going to introduce Dr. Grover and let him tell you a little bit more about himself. It's a very interesting story. But for those of you who have been following along on Facebook, I'm Benefan Petula. I'm a physician. My husband had an alcohol use disorder and struggled with that for 16 years or so before he ultimately died from it. And he left me and my 10 and 13-year-old children. And it was, needless to say, a really rough time. And after a while, I thought it would be good to try to help other people in the same situation that I am. My specific ministry is a very God-focused, scripturally based ministry focusing on how to stand strong, standing firm, to strengthen your faith so that you can withstand the storms of a loved one's addiction. And in working on that, I encountered Dr. Grover's podcasts and listened to a couple of his podcasts, reached out to him, and that's how I ended up connecting with him. I'll tell you a little bit about Dr. Grover because he has an impressive story. He went to UCLA for medical school, graduated in the top three of his class, which is really tough to do and very nice. He went to an ER residency at Stanford and then ultimately became an addiction medicine specialist. And I'm so grateful that he is here with us. And I'm going to let him tell you a little bit more about himself. So, Dr. Grover?

SPEAKER_02 3:53

Good evening. Yes. My name's Casey Grover. I graduated medical school in 2010. So I've been a physician now for 16 years. And how I got into addiction is interesting. I grew up in the central part of California, a small little coastal town called Monterey. If anyone likes Gulf, Pebble Beach is nearby. And I knew absolutely nothing about the weird things that happen in the world and some of the vices that humans have growing up in a nice community. And I knew I had to see the world. So I went off to UCLA for college. And I got into medical school at UCLA and I wanted to see patients as soon as possible. And the only opportunity was in a homeless clinic. And it was in West Hollywood. And a lot of the patients there were using methamphetamine. And I was really intrigued by this condition I knew nothing about and wanted to help. And I, because that's how I do things, threw myself 100% into learning about homeless medicine and street medicine and addiction. And I started actually working on Skid Row, which is one of the largest homeless encampments in America. And at that time was predominantly people using opioids. So I knew nothing about heroin and I went to a syringe exchange program. And they were like, Casey, do you know what people use when they're injecting drugs? And I was like, uh-uh. And so they showed me the supplies they were giving to try to reduce the transmission of HIV and hepatitis. And I went off to residency, and my wife and I had a kid, and things got hectic. And in 2013, my wife, who is another physician, took care of a 19-month-old who overdosed on opioids. And she said, this can never happen again. He got into his parents' supply, he passed, and so she single-handedly founded our little counties program to try to reduce the prescribing of opioids. And over the last 10, 12 years, we've worked on coming up with alternatives to opioids, trying to use things like acetamenophen, things like anti-inflammatories, local anesthetics like lidocaine procedures, rather than just prescribing everybody opioids for pain. And we found that there was a lot more to the story with opioids than we realized. I started learning about opioid addiction. And then we are very lucky that the American Board of Preventative Medicine allowed us the opportunity to become board certified because we've been doing so much addiction medicine on our own. So it's been a journey, and I can't say I did it myself. My spouse and partner of now almost 19 years, Dr. Reb Close and I have done it together. She also started in emergency medicine and now does addiction medicine too.

SPEAKER_00 6:30

That's fantastic. So I think you and I both have that same commitment to trying to help people who have an addiction and their loved ones. And I know tonight we have a lot of people listening in, some who may have an addiction or may think that they have one. And I know we have a lot of loved ones listening in. So why don't we start with some questions and go through some of the facts about addiction? So define addiction. What does it really mean? I know what I think it means, but I'd love to hear from you.

Defining Addiction In Plain Language

SPEAKER_02 7:02

The American Society of Addiction Medicine has an official definition. But I go to a lot of schools and talk to students and teachers about addiction. And this is what I say. An addiction is when something's hurting you and you know it and you can't stop. And there are three things that we see with addiction that make that overall high-level behavior pattern of doing something that hurts you and not stopping that we see. So the first is cravings. This is an intense desire to use the substance or do the thing, whether it's alcohol, cannabis, or gambling. We see compulsive use. So a person can't control their use. And then most importantly, this behavior causes consequences. They can be in relationships, in the workplace, in health, and the person continues to use despite those consequences.

unknown 7:57

Yeah.

SPEAKER_00 7:58

And that's I have a very similar definition with my husband who passed away from his alcohol use disorder. What I saw was an escalation of use despite those negative consequences, and pretty much a willingness to sacrifice anything to be able to drink. And it took his life. One of the things you just mentioned was you said willpower. And so, how is addiction different than I'm on a diet and I just want to pass up the donuts and the cookies in the break room at work? And I just need some self-discipline and willpower. Is that tell us how that plays into a role with addiction?

SPEAKER_02 8:34

We could spend the entire hour on that question. Addiction comes from many things in a person's life, but one of the things we've learned is that the earlier that a person is exposed to in their life, drugs and alcohol, the more the effect on the brain is. So if somebody starts using alcohol at 13, their brain grows differently than if they were exposed to alcohol at, say, 18 or 21. And you can think of addiction as a disease of executive functioning. And executive functioning is the part of your brain that allows you to keep a budget, maintain a schedule, decide what the most important thing to do in a day is. And the way I describe it to people is if you have a stroke, you don't get enough blood to one part of your brain, and one part of your brain stops working. That might be the control of your left arm or your ability to speak. The part of the brain that's broken in addiction is the decision-making part itself, the executive functioning. So people with addiction can be very frustrating, and you find yourself asking, why would you do that? Oh, wait. The part of your brain that makes decisions is broken. And that can be really hard on loved ones because they remember a time maybe there wasn't addiction and that executive functioning did work well. But it's almost like the person loses the ability to prioritize so-called normal decisions over their substance or behavior of choice as it gets worse. And we tend to see the most severe cases in people that use at really young ages because, in addition to their brain scrolling differently, like physically, they also don't learn the normal skills that we do to get into adulthood. What do I do when I'm upset? What do I do when I'm sad? I'm in the middle of class and I'm really anxious. The substance becomes the solution to everything. And so a 13-year-old who learns to smoke cannabis to deal with everything gets to 30 when they want to get sober, they don't know those skills. And the way I describe it to students is I have a stressful job. But when something bad happens when I'm a doctor, I can't just go take a break and drink a beer. I have to have those skills to manage. And it sounds like what you're saying with your husband was it initially was not so bad of a problem. But over time, his brain kept telling him alcohol was the fix. And then his addiction getting worse meant his ability to weigh out those decisions was weaker and eventually just became alcohol and alcohol. Does that sound right?

Willpower, The Brain, And Dependence

SPEAKER_00 11:05

Yeah. Absolutely. And at the beginning, it was really frustrating because I thought this is just willpower. Just you just make the decision to not do it. Then it became apparent he couldn't control it. And I think that's another part of that definition to addiction is you just can't control it. It's very different than willpower. And I think that gets into the dopamine and all that, all of that. Do you want to spend a moment just explaining that part real quickly?

SPEAKER_02 11:30

Yeah, the best way to think about willpower is it's a fatigable muscle. So if you and I are somewhere and we're hanging on a cliff for our life, even though we will die, our muscles will become tired and we will let go. And that's scary to think about, but willpower is the same way. And what I work with for my patients on willpower is we have to be mindful about when we are at our weakest. So on a good day, my patients, maybe with willpower, can say, not today. But things that stress us out hunger, anger, loneliness, fatigue, illness, H A L T S, that's when I'm a bad parent, right? Love my kid, she's awesome. But if I'm hungry and angry and lonely and I'm sick, she might get a kind of a snotty remark out of me when she says something that I really didn't mean. But what I work with my patients on is identifying those triggers as they get better and to try to take the willpower they have and make it the most effective and reaching out for support when they're in those high stress states. The other part of it though is willpower is great, but once a person becomes dependent on a substance, then we have a physical component and alcohol is particularly destructive. So a person who drinks every day will develop what's called alcohol dependence. Their brain chemistry changes, and when they stop, they can be very ill. It can actually be life-threatening with alcohol. And so what'll happen is someone might be ready, but when they stop, they get so sick they're actually sucked back into it to try to not be vomiting and shaky or even have seizures. So it's almost like we need to identify it early or even prevent it, because once those brain chemistry changes happen, it's much more difficult to treat.

unknown 13:20

Yeah.

SPEAKER_00 13:20

So what I hear you say is there's a change in the brain with the dopamine and that willpower part that gets out of control. But even if someone gets ready to try to stop, and this is with drugs too, right? Not just alcohol, any of the substances, if you stop cold turkey, you end up in those withdrawals, which are very physically uncomfortable and they can cause some hallucinations, both things you're hearing, things you're seeing, cause the heart rate to go real fast, and just an awful anxiety feeling. And I think people then immediately go back to that substance because it takes away those withdrawal symptoms and you get in this vicious loop. So tell me then, how do you definitively diagnose an addiction then? So for say for the person who's out there who thinks, boy, I may have a problem with alcohol or drugs or gambling or an addiction to sex or an addiction to porn, how do I know I have an addiction? And then I have a follow-up question from the family member side. If you want to take the question about how does the individual know? How do you how and how do you, as a doctor, what blood test do you do to definitively diagnose an addiction? Is there a test?

Withdrawal, Dopamine, And The Vicious Loop

SPEAKER_02 14:29

I think it depends. So when we look at actually making the diagnosis of addiction, like mental health conditions, there often is not a definitive blood test, right? We use the diagnostic and statistical manual, the DSM. It's basically the big book of diagnostic criteria for psychiatry, and we're in our fifth edition. So it's the DSM five. And there are 11 criteria to diagnose addiction. So there's 11 criteria for alcohol, and then there's those same 11 criteria for cannabis, for cocaine, for opioids. And they fall basically into the three C's cravings, compulsive use, and using despite consequences. And if it'd be helpful, I can read through the 11. But two to three of those criteria, you have a mild use disorder, four to five is moderate, and six plus is severe. They're similar. Some of them don't yet have a diagnostic criteria like video game addiction or social media addiction. Gambling does have a diagnostic criteria for addiction. It's only nine criteria. I don't know the history behind it, it's just it's slightly different. And it's likely because it's a behavior as opposed to consumption of a substance. Asking about can you diagnose someone based on a blood test? Maybe. If somebody, if you're admitting them to the hospital and they're looking at you and they don't appear intoxicated, and something about them says, I wonder if there could be an alcohol component here and you get a blood alcohol level and it's very elevated and they don't appear intoxicated at all, that suggests they have tolerance, meaning that they can tolerate more of the substance without appearing intoxicated and would be highly suggestive of an underlying alcohol use disorder. So the legal limit to drive is 0.08. If anyone's 0.2 or higher and they don't appear intoxicated, that's a major red flag. But the diagnostic criteria still remain those 11 criteria.

SPEAKER_00 16:36

So as a physician, I rely on that sometimes when I'll get a blood alcohol level and they're I'm thinking you should be passed out by now, but you're just awake and alert. So that gives you an idea. Now, let's talk from the family member's perspective. So you have a loved one, maybe a parent, spouse, sibling, best friend, and we love somebody that we think has an addiction or a substance use disorder. And I think there's a lot of us. One of the questions that I got, and one of the questions I had early on in my husband's disease was, Am I crazy? I think there's something going on here. And when I ask about it or try to approach it, I I walk away thinking, okay, I maybe I'm overreacting, maybe I'm being dramatic. How does the loved one confidently know my loved one has an addiction and I'm not just overreacting or being overly dramatic?

How Doctors Diagnose Addiction

SPEAKER_02 17:27

What would you suggest there? So I think there's two flavors of this question. The first, is it an illegal substance? If they're willing to spend time and money to get an illegal substance, that's very concerning that there's an addiction, right? There's no a good reason to buy an illegal substance like cocaine to make the fireplace look nice, right? It's just if a person's buying an illegal substance, that's obviously very concerning. There are major consequences, and they're ignoring that. Now legal substances can be harder. And there's a lot of normalization of heavy drinking. Generationally, each of the last few generations has had a different relationship with alcohol. Gen Z is my daughter's generation. They are drinking less than ever before, but they are using more cannabis. Baby boomers, alcohol drinking heavy was fairly normal. Millennials are drinking less. Gen X drinks more than millennials, but not as much as Boomers. So, depending on a person's social circle, 10 drinks on a Friday night might feel normal. The official answer is unhealthy levels of alcohol are more than seven drinks a week for women and more than 14 drinks a week for men. And women, it's considered binge drinking for four or more drinks in a single setting, and for men, five or more drinks in a single setting. And I am actually this week going to one of the local high schools I work with and actually giving the kids those numbers. Because I went off to college and everybody was getting just absolutely hammered. And I was like, okay, I guess that's what you're supposed to do, or in college. So, yes. So the first thing is when you are thinking about a loved one, you need some numbers to make you actually able to check what you're feeling. Because it's easy to feel emotional, like I'm just worried. I feel like he's always got a glass of wine in his hand. So the start with the finances. How much is your loved one spending on alcohol a week? How much is your loved one spending on cannabis a week? Sweetheart, I realize you think this is social, but we spent$3,500 on alcohol this month. That's a lot. I sometimes actually, with my cannabis patients, because it's harder to quantify, I actually just asked them, what'd you spend on cannabis this week? And then we try to trend that down. Okay, it was$50 on cannabis this week. Let's see if we can get down to 45 this week. The other thing is if you are counting, again, more than five drinks for men in a single serving is binge drinking. More than 14 drinks in a week is unhealthy alcohol consumption. And for women, those numbers are four in a single setting and seven in a week. And you can say you're going above what's considered into unsafe levels. I think we should come down to this level. And if they don't, that goes back to the third C. They are going to face some health consequences, and they yet they are pursuing that behavior despite that.

SPEAKER_00 20:19

Right. I've had patients and also my own experience where, okay, so there's a number, seven, seven drinks. Just pour a bigger glass. So now I'm only having three, right? Or change the type of substance. Instead of use drinking maybe just beer, I'm gonna go to the harder stuff. I'm gonna start hitting whiskey or bourbon or something, and it's a little bit stronger. Because when I have one glass of that, it's much much higher alcohol content. So I think those things need to be taken into account as well when you're talking about the numbers.

SPEAKER_02 20:53

So for me in my world, one drink is a drink. It's 14 grams of alcohol, which one 12 ounce, 5% beer. In this era of IPAs, they're up to like almost 10%. It's one five-ounce glass of 12% wine, not 14%, not 13%, 12%, and one 40% one and a half fluid ounce shot.

SPEAKER_00 21:15

Yeah.

SPEAKER_02 21:16

So it it depends on the type of alcohol, too. And what I tell the the high schoolers is do I want you to drink? No. But if you're gonna drink, get the beer. It's weaker, it's sealed, no one can put stuff in it, and you only get one. If you buy a 750 milliliter bottle of rum, that's 17 drinks.

SPEAKER_01 21:33

Yeah.

SPEAKER_02 21:34

So it's much harder for patients to self-regulate. And yes, very few adults measure. That is what it is. And yes, absolutely, people will make their glasses bigger to say it's only one.

SPEAKER_00 21:45

What would you say is the single best thing that you see someone who has an addiction do to try to help stock their addiction? What's one of the what's like the most important thing I want? The best things they can do.

Red Flags Families Can Trust

SPEAKER_02 22:01

You may not be expecting this. Tolerate discomfort and be vulnerable. So let's come back to a case like your husband's. I'll make a fictitious patient just so it's not about anyone in particular. So let's say a fictitious 50-year-old man comes to me, Dr. Grover, I need to quit alcohol. Okay. What makes you drink? I can't sleep. Okay. What does alcohol do for you? Oh, when I drink, I sleep a lot better. Okay. What happens if you don't drink? Oh, I can't sleep. I can't sleep. The inability to tolerate that insomnia, sleepless night, working on sleep hygiene, cognitive behavioral therapy for insomnia, that person's not ready yet. On the flip side, people find that the substance they use makes them feel better in the short term and can really mask some horrible things. One of my patients who I saw today was trafficked. She was a victim of human trafficking. And trying to rebuild a family after emerging from trafficking is awful. But you know what? The cocaine makes it hurt less. And so she's trying to put together enough resources so she can tolerate that pain of her PTSD from being trafficked. She's trying to find support in meetings. She's trying to find an outpatient program that she likes. She's in couples therapy. She's seeing me. And her trauma is so profound, I don't know that she's ready yet. But getting sober, you have to deal with all the horrible things that you didn't like that made you use the substance. And when someone's really ready, it's hard. And they, if we do it right, they have enough resources and support that it makes it less uncomfortable.

SPEAKER_00 23:57

Sure. I hope and pray your patient does well. That's just so challenging. You said two things. Tolerate discomfort. And what was the other thing you said?

SPEAKER_02 24:06

A willingness to be vulnerable.

SPEAKER_00 24:08

Willingness to be vulnerable. So you mentioned PTSD. So things like anxiety and depression and being uncomfortable, having some discomfort from whatever. Is talk about how using a substance can be self-medicating and how do you approach that from if it's you as the person who has maybe some anxiety and use a substance in order to just help that be easier so you can actually go to work and go to school, or if you're the loved one who can see your loved one has maybe some untreated depression and anxiety, and you it's obvious they're self-medicating. What would you recommend for both of those people?

What Counts As One Drink

SPEAKER_02 24:56

It's interesting, right? The substances offer a short-term relief. The problem is they lead to long-term harm, right? So no one's coming to me because Prozac ruined their life. Right. And I ruined my life. I lost my job because of my therapist. I shouldn't say very few. No one has ever come to me that. Yeah. It's really funny. Many moons ago, I was like, oh, addiction is just self-medication. I went through all this school and all this training. Yeah, most of addiction is self-medicating. There's a subset that have a different response to substances in their brain than the average person, and that's largely genetic. And actually, those are some of the patients in whom medication is the most effective. But yeah, anxiety, depression, insomnia, PTSD, loneliness, sadness. My patients tell me all the time, Doc, I just it numbs it. So here's my perspective. My hope is that I can understand them well enough to find a medicine or a means of therapy or a type of group meeting that makes what they're going through less bad so that they can stop using the drugs and alcohol and start feeling okay with what I'm giving them. And really the best question I ask people is what does this do for you? If you think about it, somebody with alcohol, let's say they've had a DUI, so there are consequences, they want to go to the store after a couple of beers to buy more. They're spending money, they're spending their time, and they're taking risk. And then my patients who use illegal substances, yeah, time, money, risk. The brain wants something. And if we can figure out what that is, and my fictitious case of the 50-year-old who can't sleep, shoot, let's try a non-addictive sleep aid. Like we can come up with something that allows you to get away from what you were doing that was harmful and make some of that vulnerability and discomfort not as bad, just so you're willing to even dip your toe in the water of trying to get off the substance and realizing it's doable.

SPEAKER_00 27:11

I think that's really hard to tolerate discomfort and be vulnerable. It's so difficult. But you might ask me, so for those of you who don't know, I was on Dr. Grover's podcast, Addiction Medicine Made Easy. And it's a great podcast. I've learned a lot by listening to it. And one of the questions that he asked me was, Do I think I have PTSD from my husband's alcoholism and death and all of that? And I said, I don't, I really don't think so. And I don't think I have true diagnosed PTSD. But do I still struggle with that? Does it still make me sad? Do I still get a little angry over it? Absolutely. And I think being vulnerable and being able to talk about that discomfort, it's really difficult. It's taken me a long time to be able to do what I'm doing to try to help others. I just, it's a challenging thing. But let's talk about the resources that you mentioned too. So you mentioned all of these resources: couples therapy, counseling, meeting with you, maybe some medication to help. Which which one of those is the best?

The Single Best First Step: Vulnerability

Self‑Medication And Treating The Root Cause

SPEAKER_02 28:17

The way I think of it in my mind is it's a stool. And there are three legs. Okay. There's medication, there's therapy, and there's group meetings. And if you want the stool to be stable, you want it to have three legs. Let's say a person's not a medication person. You know what? We can probably make it balance on two legs with just meetings and counseling. But if we are only doing one, that's pretty unsteady. And when someone says, I don't want any of them, I'll be fine, they've already fallen. I can count zero people who have said to me, I don't want anything, I'll be fine, and they are. And there's probably a bias there, right? Plenty of people identify a problem and get sober completely on their own. But the ones that see me, just the referral bias, I'm going to get the more severe cases. So let's imagine that a person on this webinar or Facebook Live says, I'm ready for help. Alcoholics Anonymous, narcotics anonymous, all these 12-set meetings are free and everywhere. You can attend them on Zoom. If you're worried about being recognized, go to one in Australia on Zoom. Go to one in England on Zoom. You can enjoy the accent as well. So, why do these meetings work? There's two things. The first is it's structured. There are 12 steps. You are given a sponsor, you are given responsibilities by how to work with that sponsor, and you work a specific program. Now, some of my patients are religious, some of my patients are not. Some 12-step meetings are deeply religious, others are not. And the analogy I make is Brenda, if you and I go to a car dealership and you pick out the Toyota Tacoma and I pick out the Ford Mustang, we're both right. You have what you like, I have what I like, and meetings have personalities. And so if you go to a meeting and you're like, whoa, this is not for me, you need to find the right make and model, if you will. So free, easy, supportive. And then one of the things we are wired for as humans is positive human connection. That releases the pleasure hormone dopamine. And when you go to a meeting and people are happy to see you, that's dopamine. And in early recovery, you've used the drug or the alcohol to release the dopamine to feel good, and you run out. And that like initial attempt to get sober is depression and no energy and no motivation. But when you go to a meeting and people are happy to see you and they clap for your 24-hour chip, meaning being 24 hours sober, that's dopamine. Now, the next is therapy. And there's a bunch of different modalities: cognitive behavioral therapy, dialectical behavioral therapy, couples therapy, experiential therapy, don't sweat the details. Same thing. If we go to a car dealership and now you pick out the Mustang and I pick out the Tacoma, we're both still right. Meaning, if you go to a therapist and you're like, this makes no sense. I don't understand this person, that is not a good fit. And that's okay. It is more about finding a therapist that you trust and get along with and understand because when you trust them, it's much easier to be vulnerable. Right. There are some online resources. There's, I think Talkspace is one online one. BetterHelp is another one. These are big repositories of lots of therapists across the nation who are working on Zoom. You can literally, super private, super discreet, in your car, plop the phone on the steering wheel, and plug into therapy. You may also want to see someone in person. It depends on insurance and financial resources, unfortunately. Meetings are great because they're free. And then addiction medicine, there's not a ton of us. So there's a several thousand doctor shortage in my specialty. But if you go to your local hospital's website, you can search by doctor specialties. So if you look up your name, you would come up under hospitalist and family medicine. You can search the hospital near you and see if there is an addiction medicine doctor. If they have one on staff, meaning there's a doctor that works there, you can see if they're taking new patients. And then every drug and alcohol treatment program, for the most part, if they're prescribing medications, have a medical director, meaning that there's a physician involved. So the physician piece might be a little bit harder to find if some of the listeners are in, say, a big place like Dallas or New York City. It's pretty easy. But in a very rural area, sometimes it's telemedicine or remote medical care that's the best option.

SPEAKER_00 32:55

Yeah, we have a lot of nonprofit community organizations that work on that in our area too. So those are other resources where they have physicians who sometimes volunteer their time to help. And that's great too. The tripod's an interesting concept of your stool. And I say the same thing for the loved ones. Because really, you have to take care of those three aspects. And one of them I say is the physical side. I I don't know if I told you the story on the podcast interview, but I was completely convinced I had something wrong with my gallbladder because I was constantly nauseated and lost so much weight. And yeah, I'm scrawny to start. So I had gotten seriously underweight and no appetite and constant nausea. And I was convinced it was my gallbladder. And my doctor, who was wonderful, sat and talked with me and found out what was really going on at home, which is really what was causing my nausea and lack of appetite. But I think we have to take care of the physical side, treat ourselves well, good sleep, good food, not neglecting to take care of those basics. So we're physically feeling good. I think we have to deal with the mental and emotional part of it too, from our perspective, because that stress of having a family member with an addiction, whether it's a substance or gambling or sex or porn or spending, it's stressful. There's for some of us, there's never that sense of stability or reliability. And it's you just can't count on a holiday going well or a social event going well, or you just maybe stop going because it's too risky. And then I always like the spiritual part, and that's part of my ministry too, is I think when you have a firm, strong foundation and a belief, I think it it really ties everything else together. And I agree, you need those three. And if you're missing one of those legs, I think your everything just collapses. And that's what I did. I just kind of I didn't have a solid tripod going at the time. So it was difficult. Let's talk for a moment about stigma, because you mentioned how going to a group and being in a relational group with people and having people celebrate with you when you've been successful is so important. And we spoke on the podcast about the stigma I was worried about. I was worried about people knowing my husband had an alcohol use disorder and I was worried I was gonna lose my job. And so I didn't really talk with anybody or share that with many people. And your series, your podcast series on stigma is really well done. And quite frankly, for those of you listening, I really encourage you to check it out. It's the main reason I contacted Dr. Grover because he was so understanding about the stigma and its effect and its impact as being a barrier to getting help. So let's talk about the stigma a little. What does that mean? And what do you see as ways we can overcome that? I think if I had talked with more people at work, felt more confident about that, there were so many people in the exact same situation, and we just never knew it. We couldn't be a resource for each other.

The Three‑Legged Stool Of Recovery

SPEAKER_02 35:56

So this again could be an entire hour. In fact, I actually have an hour-long lecture I give on stigma. So, yes, stigma is essentially a sense of otherness. So the term stigma actually comes from ancient times where they would scar criminals, and it was a mark that was identifying for them as a criminal. And essentially you can think of a person's diagnosis as their scar. Oh, hey, it's great to meet you. Whoa, you have Alzheimer's disease? Whoa. Hey, whoa, you have seizures? There's a judgment, there's a perception from the healthcare provider or the community or loved ones that the person has done something wrong. And it's very much a kind of an us them feeling. And in my world of healthcare, most healthcare providers are fairly functional. We do have healthcare providers with addiction, right? But for the most part, we go to college and go to school and then show up to work every day. And if we do have an addiction, we hide it really well. And we'll see people and their lived experiences are so different that are just like, oh gosh. And people feel it about all sorts of stuff: mental health conditions, urinary incontinence, psoriasis, like all these medical conditions where the healthcare provider looks at them and be like, Why aren't you doing X? Why aren't you doing Y? That's why everyone lies to their doctor. Everyone lies to their doctor. Just did you do this? Oh, of course.

unknown 37:21

Yeah.

SPEAKER_00 37:21

When they ask me if I'm fasting for a blood test, my lady goes, Are you really? And I said, She totally busts me. I go, Why do I still have chocolate on my face? She's I know you weren't fasting. Anyhow, go on. But we do.

SPEAKER_02 37:36

Yeah, some diseases are less stigmatized than others. High blood pressure is not particularly stigmatized. High cholesterol, not as much. Obesity is. Some of the serious mental health conditions are, particularly schizophrenia. Addictions are very heavily stigmatized. Dementia, oh, that's a really tough one. A person who really can't understand what's happening is acting out. It's thought to be volitional. But essentially, stigma is a person feels judged. And we really try to create a stigma-free environment in our practice. We hire people in recovery who are open about their recovery to do what's called peer support. Hey man, two days sober. High five. I remember when I was two days sober. And then for me, I tell my patients all the time look, your insurance pays me as your doctor to care about you, not judge you. Medicaid did not pay me to treat you badly today. They paid me to treat you with kindness and respect. But I am very aware that my addiction patients get treated badly by the medical system. And that goes back to ability to tolerate discomfort, shame, guilt, feeling that stigma, and vulnerability. If you're really going to do it, you may need to own it. And it may be that you work in quiet and get sober and then come back to people and you don't give the specifics of, oh yeah, I'm sober, been working on it for a while. But yeah. The other part of it is there are some serious consequences. For you and I as physicians, if we have addiction, it changes our ability to have a medical license. My patients who are parents having an active addiction may impair their ability to keep their kids, which comes back to that third sea of consequences. Is this the million-dollar question in addiction medicine as I see it? Is for anyone who's got a loved one that they're worried about, and we talked about this with your husband, your late husband, sorry. When do you lift them up and help them when they're struggling? Or but are you enabling them? Are you making it worse? When do you give them hard love? When do you hold them accountable? And the answer is nobody knows. It's very individualized.

SPEAKER_00 39:43

But I was really hoping you had the answer to that.

SPEAKER_02 39:47

The answer is it varies person to person. We usually start with the carrot, meaning we start with helping. And if that doesn't work, we start moving towards the stick, pushing towards accountability. But yeah, it's a very tough question. And that comes back to stigma is people know that they're gonna face consequences, and if they hide it, they don't have to face them.

Stigma And How To Disarm It

SPEAKER_00 40:12

And I don't just think of stigma about being within medicine either. I I think about it as existing outside of medicine too. We have just as a simple example on social media, on LinkedIn, the professional social media site, I posted something about something at work, right? Whole bunch of likes, the thumbs up, the hearts, comments, a lot of them. I post the podcast that you and I did on Wonderful Person, Horrible Disease, like two likes, no comment, maybe one comment. But even that, I thought people don't know how to approach addiction. The the other comment about work that I posted was just very popular, but this really important part just got a couple of likes. And I think people just are nervous. They don't know what to say, they don't know how to approach it. And I think for me, having gone through this, I think it would have been wonderful if someone had said, what's going on? But I think because they sense my reluctance to talk about it, it makes them uncomfortable. And then nobody knows how to address it. Does that make sense?

SPEAKER_02 41:23

Yeah, absolutely. And humans have had a complicated relationship with substances for thousands and thousands of years. The ancient Greeks talked about how much they drank and people used cannabis and ayahuasca and all this stuff. Addiction was beaten into our brains in the 1950s and around that same time as a moral failing. Harry Anslinger and the Federal Bureau of Narcotics really went for a draconian people with addiction are weak and immoral approach that ultimately fed its way into the war on drugs. And yeah, nobody, when I go to a school, when I ask the kids, what do you want to be when you grow up says addicted? There's this sense of I let my parents down, I let my mom down, I'm letting my husband down, I let myself down. This was never supposed to happen. I was better than this. It's very unpleasant when people come to terms with the fact that they are facing addiction.

SPEAKER_00 42:18

Yeah, it becomes this very vicious cycle. And that was one of the things I think you and your specialty do very well is being very respectful, very compassionate. You talk about using first-person language, the person, not the alcoholic, not the addict, the person who has a substance use disorder. It's this is a person first who has a problem. And quite frankly, it's easier for me to say now that I'm not in the middle of it, I'm not dealing with it. That was I would have been very angry talking about it back then. Even now I try to talk about he was a good man, bad disease, and also to recognize we all are people, and every one of us has a problem and a struggle. When some of our problems and struggles are just more public and cause more consequences.

SPEAKER_02 43:07

But if I can push back on that a little bit, but when we talked about your husband's story, there were not the resources like what we're talking about. Sure, meetings have been around for lots of years, but to actually see a physician with training like mine with your husband early on, the entire course of his lived experience could have been different. So, yeah, people come to me now and they're amazed. They're like, Dr. Grover, I've been trying to get off meth for 30 years. How is it no one prescribed me this medication 30 years ago? And if there's anything good about America's horrible relationship with opioids over the last 30 years, is it raised awareness that addiction needs more help? So I obviously can't coulda, woulda, shoulda with what your husband's lived experience was. But I just want to raise the question had there been more access to addiction? Medicine services. Could it have been different? The answer is a decided maybe.

SPEAKER_00 44:04

Yeah. And I think with that too, one of the things we talked about is working on sobriety from the person who has the addiction. They have to want to do that too, right? Because they have to be willing to tolerate that discomfort and be willing to be vulnerable and be willing to say, hey, I've messed up. I need help. That's a really hard thing to say. And like you said, a lot of us lie to our doctors, how many people are honest at the dentist? Of course I brush and floss twice a day, every day without fail, right? No one wants to say, I'm screwing up and then be reprimanded or told you're doing that wrong. We all get that. But at the same time, there are some folks who truly aren't ready. They're not in that stage where they're willing to make a change. And you and I talked a little bit about that, about how I felt I was working harder at his sobriety than he was. And what would you recommend for those loved ones in that spot? What can they do to try to help their loved ones understand this is something so important? We have to be careful with our words and not try to force them to get help. We don't want to alienate them, but what can we do?

Help Or Enable: Finding The Line

SPEAKER_02 45:14

So I can't take credit for what I'm about to say. You guys, we were talking before, why do I do my podcast? It really helps my patients and their families. They will ask me a complicated question. I will send them a 40-minute episode that goes through it. And if you search on YouTube for put the shovel down, there's a therapist on the East Coast named Amber. And I think she is a genius because she did a podcast episode with me on how do you help the person that isn't ready to change. And the first thing she says is, you have to stop being the villain. That the relationship gets so contentious when a partner wants their loved one to be sober that the partner feels like they're constantly being criticized and there's not a lot of positivity. And so that's what she says. The first thing is, you've got to stop being the villain. And I thought about that and I was like, does that make sense to me? Do I like tell my loved one, drink as much as you want? And it was more that when you come to your loved one with concerns, be willing to ask genuine questions and then be willing to actually listen to what they say. I'll give you an example. I'm really worried, you're drinking too much, I want you to cut down. That is a very true statement. And the way she frames it is sweetheart, I love you. I just want to let you know I'm a little worried. Can you help me understand? You really seem to need the alcohol. What is it you're needing? What are you feeling? And then being willing to actually stop and listen. And this is not just what we see in Amber's work. There's actually literature on this that when we as doctors tell patients to quit cannabis, they say, no one asked me why I was using it. No one helped me identify what conditions I have that I'm self-treating with cannabis. And no one offered to help me treat those conditions without cannabis. And the other thing that she actually does, and this is really cool, and I encourage Amber to write this up as a scientific paper. But what she does in her model is she doesn't actually have the family members communicate with each other because there's so much history and tension. Her program involves the family gets a counselor, and the person with addiction gets a counselor, and they meet individually, and when they come together, the therapists do the talking. Oh. She calls it lawyering up. I was gonna say it sounds like that. And this is what I see in my practice. Teenage visits are the hardest of anything I do because I am not a doctor, I am the referee. Mom is upset and she's doing this, and the kid's upset and they're doing this, and they just do this all visit. And sometimes I can barely get a word in edge-wise. And so what Amber has done is she wants the family member to be perceived as on that loved one with addictions team, and that when they negotiate, it's towards a common goal, not like they have separate goals. And Amber has a ton of awesome videos. And if you're wondering, her podcast, Put the Shovel Down, is you don't actually need to dig any deeper to hit rock bottom. Now it's fine. Put the shovel down. Super smart, clever lady. I was so impressed with her. She has an episode on my podcast, which is how to help someone who's not ready to change. And she has other things that she does. But that goes back to what does I do as a doctor? If I tell you you need to quit drinking, I'm gonna get not much. But if I really listen and seek to understand, that's when I make the progress.

SPEAKER_00 48:47

Yeah. And I think you're right. I think the person who has the addiction already knows they should quit and cut down. But that's not giving them any tools to do it. It's just telling them what they already do know. And I like that approach to help me understand why. We're almost out of time. So let me ask you one more question, unless you have anything else you specifically want to say or cover.

Talking To Someone Not Ready To Change

SPEAKER_02 49:08

No, the other thing I would say is sometimes the conversation around addiction takes time. It's like a fruit. It takes time to grow and ripen and be ready to be harvested. And I'll give you an example. I have a young man, he's in his teens, and his family came to me like he's vaping, he's using nicotine. And knowing how the teenage brain works, I did not come in with anything except just listening. And I didn't even tell him, even though I knew day one he had an addiction, I didn't tell him. And I'd ask him, like, I would like you to give me some ideas on what you can do and let's do it. And then he wouldn't do them. And he continued to vape. And I'd be like, okay, that didn't work. Let's try this. And that's actually one of the things Amber does in her work is she says, let your family member make suggestions. I'm only going to drink red wine this week. Okay, let's try it. And when it doesn't work, at least they know that you're willing to work with them. And so what I did with this young man is about two months into seeing him, I said, let's just kind of put our heads together here. Addiction has really three things, right? Cravings, compulsive use, and uses by consequences. I'm seeing that you're getting some consequences. And we thought this was maybe some casual teenage experimentation, but if you keep using, we really may need to consider that this is an addiction. And the last visit, that was the conversation that we had. And that did not feel good for him. But I build enough trust with him that he knew I was on his side. And I was almost like I was, oh, this hurts me to say, but I think we need to bring up the A word. And it's so far, it's been helpful. Granted, he's 16, so it changes week to week. But that may be something for someone listening, being like, I think my loved one's addicted. I'm just gonna start asking some honest questions and we'll do a little bit of homework. And I'm not gonna bring it up now, but I'm gonna bring it up in a few weeks or months and just be like, we've really been trying, and you're not able to stop. Maybe this could be addiction. Just want to throw that out there.

SPEAKER_00 50:56

Do you think in your experience, do you see that most of the folks have a concomitant mental health problem that's not being treated like anxiety or depression or PTSD?

SPEAKER_02 51:09

95 plus percent.

SPEAKER_00 51:12

Yeah. Yeah, that's my experience too. And the data shows that as well.

SPEAKER_02 51:16

Yeah, it's uh we call it dual diagnosis, meaning that they have mental health and addiction. It's all dual diagnosis. There's a rare subset. It's usually like an older, over 50 patient. They've been successful despite their substance use, and they just get an exaggerated pleasure response to the drug, usually alcohol. And it's really just their brains wired to love the substance, but that is definitely the minority.

SPEAKER_00 51:41

All right, one more question for you. So you talked on your podcast on one episode, you did a real short episode on looking at some of the studies out there that looked at the children of folks who had substance abuse disorders. And I think one of the things some of those studies looked at, I think if I remember correctly, the concept was in my situation, I invested interest in this, right? My husband had an alcohol use disorder, died from it. And the question was, what do I do with my kids with alcohol? Do I let them do I take the mystery out of it ahead of time before they go off to college and encounter college drinking and other things? And I found what you said about those studies really interesting. And so do you maybe want to summarize what advice you would give to parents who have kids that they're worried about having an addiction because maybe their other parent did?

SPEAKER_02 52:41

Yeah, I was trying to find the episode, but I can't find it that quickly. But here's the basic idea. So my parents had the perspective of it's really unsupervised drug and alcohol use that's the problem, right? If we teach Casey how to drink responsibly at home, he'll be fine. In Europe, they do it all the time. The kids grow up with alcohol, it's no big deal. They must not have alcohol addiction. That is 100% false. So the data would suggest whether it's in your home with friends or wherever, the earlier they are exposed to the substance, the greater the likelihood of addiction. There was actually one study, it was fascinating, that actually looked at parents who gave kids alcohol in their home in a supervised setting, not like the blind eye parents who let their kids party, but Bobby, this is a Merlot. We're gonna have it for dinner tonight because we're pairing it with beef. What they found is in the parents that turned a blind eye and just let their kids use, highest rate of addiction. The parents who said, our home is alcohol-free under 21, those had the lowest rates of addiction. But the parents who offered their kids alcohol to teach them, the parent perception was that their consumption was down, but those kids consumed about as much as the kids whose parents turned a blind eye, and that their use patterned those kids who turned whose parents turned a blind eye into college. So the per parents felt like they were doing a good job, but regular exposure to alcohol at an earlier age was not protective. The best way to think of it is we have two times in our life where our brain is growing the fastest. When we are toddlers, right? We have to learn to walk and talk and use a screwdriver and eat.

SPEAKER_00 54:32

Yeah, I know.

Teens, Vaping, And Building Trust

SPEAKER_02 54:34

My first screwdriver. So, yes, we learn dexterity, we learn all that when we're toddlers. And then the teenage years. And when the teenage brain is exposed to substances, interestingly, particularly cannabis, it does not grow the same way. And so the single best thing a parent can do is say, no, you may want to use alcohol, you may want to use cannabis, you may want to use nicotine. Those are legal substances, but there's a reason why they should not be consumed until you're 21. If a kid starts using drugs and alcohol before the age of 13, they have about a two-thirds chance of developing addiction. If they wait until 21 or later, that risk of addiction drops to less than one in 10.

SPEAKER_00 55:15

Wow, that's pretty significant.

SPEAKER_02 55:17

That's that's a pretty good number needed to treat my fellow physician.

SPEAKER_00 55:21

Yes, it sure is. Do you have anything else you would like to add before we wrap up?

SPEAKER_02 55:27

Just if anyone out there is struggling, I'm sorry. I see my patients struggle, it's really hard. I just glad you took the time to listen tonight. And for anyone who's out there loving someone with addiction, I'm sorry. It's hard. It's really hard. And for family members, things like Nara-Non and Al-A-Non are family recovery-focused meetings, and they can be absolutely life-changing to realize that you're not alone. No, you're not making this up. It's a problem, and it's hard. And just thank you, as a fellow physician, being open-minded about treating addiction. I find a lot of my primary care colleagues just aren't interested. So thank you for being you.

SPEAKER_00 56:05

Yeah, thank you very much.

SPEAKER_02 56:16

Thank you so much for listening to Addiction Medicine Made Easy. If you found this helpful, please leave a review. It really helps others find the show. And a huge thank you to Central Coast Overdose Prevention for supporting this podcast. And always remember: treating addiction saves lives.